Murat İNAL, Şivekar TINAR, Deniz BALSAK, Yusuf YILDIRIM

Overin malign mikst müllerian tümörü: Klinikopatolojik özellikler, tedavi ve prognoz

Nadir görülen bir tümör olan Overyan Malign Mikst Müllarian Tümör (OMMMT)'ün klinikopatolojik özelliklerinin değerlendirilmesi amaçlandı. Ege Doğumevi ve Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Jinekolojik Onkoloji Departmanı'nda 1998-2006 yılları arasında, OMMMT tanısı alan toplam 5 olgu retrospektif olarak analiz edildi. Demografik ve hastalıkla ilişkili faktörler, tedavi yöntemleri ve prognoz değerlendirildi. Ortalama yaş 54.5±8.2 idi. En sık prezentasyon şekli pelvik kitle ve assitdi. Tanı anında 3 olgu ileri evre hastalığa (2 FIGO IIIC, 1 FIGO IV) sahipdi. Tüm olgulara sitoredüktif cerrahi (3 optimal, 2 suboptimal) ve platinum bazlı sitotoksik kemoterapi uygulandı. Evre IV hastalığa sahip 1 olgu'da primer cerrahiden 3 ay sonra rekürrens gelişti. Bu olguya ikinci sıra (second-line) kemoterapi (carboplatin + ifosphamide + mesna + etoposide) uygulandı. Ortalama izlem süresi 18.6±3.5 aydı. Çalışmanın sonunda sadece 1 (%20) hasta hayatta ve progresyonsuzdu. OMMMT'nin klinik prezentasyon ve tedavi metodları epitelyal overyan kanserlerinkine benzemesine rağmen, prognoz genellikle daha kötüdür. Şurası kesindir ki, prognozu iyileştirmek için yeni sistemik tedavi modalitelerine ihtiyaç vardır.

Malignant mixed müllerian tumor of the ovary: Clinicopathologic characteristics, treatment and outcome

We aimed to evaluate clinicopathologic characteristics of Malignant Mixed Müllerian Tumor of the ovary (OMMMT) that is a rare malignancy. A total of 5 cases diagnosed with OMMMT at Aegean Obstetrics and Gynecology Training and Research Hospital, Department of Gynecologic Oncology, between 1998 and 2006, were retrospectively analyzed. Demographic and disease-related characteristics, treatment modalities and outcome were evaluated. The median age was 54.5±8.2. A pelvic mass and ascites were the most common presentations. Three patients were diagnosed with advanced diseases (two FIGO stage IIIC and one stage IV). All patients underwent cytoreductive surgery (3 optimal, 2 suboptimal) and platinum based cytotoxic chemotherapy. One patient with stage IV disease developed recurrence 3 months after surgery. Second line chemotherapy (carboplatin + ifosphamide + mesna + etoposide) was administered in this patient. The mean follow-up was 18.6±3.5 months. At the end of the study, only one patient was alive and progression-free. Although clinical presentation and treatment methods of ovarian MMMT are similar to those of epithelial ovarian cancer, the prognosis is generally poorer. Clearly, new systemic treatment modalities are needed to improve prognosis.

PDF

___

1. Muntz HG, Jones MA, Goff BA, Fuller AF Jr, Nikrui N, Rice LW, et al. Malignant mixed mullerian tumor of the ovary. Experience with cytoreduction and combination chemotherapy. Cancer 1995; 76: 1209-13
2. Barnholtz-Sloan J, Morris R, Malone J, Munkarah AR. Survival of women diagnosed with mixed malignant mullerian tumors of the ovary. Gynecol Oncol 2004; 93: 506-12
3. Brown E, Stewart M, Rye T, Al-Nafussi A, Williams AR, Bradburn M, et al. Carcinosarcoma of the ovary: 19 years of prospective data from a single center. Cancer 2004; 100: 2148-54
4. Rebischung C, Pautier P, Morice P, Lhomme C, Duvillard P. α-Fetoprotein production by a malignant mixed mullerian tumor of the ovary. Gynecol Oncol 2000;77: 203-5
5. Barakat RR, Rubin SC, Wong G, Saigo PE, Markman M, Hoskins WJ. Mixed mesodermal tumors of the ovary: Analysis of prognostic factors in 31 cases. Obstet Gynecol 1992; 80: 660-4
6. Plaxe SC, Dottino PR, Goodman HM, Deligdisch L, Idelson M, Cohen CJ. Clinical features of advanced ovarian mixed mesodermal tumors and treatment with doxorubicin- and cisplatinum- based chemotherapy. Gynecol Oncol 1990; 37: 244-9
7. Duska LR, Garrett A, Eltabbakh GH, Oliva E, Penson R, Fuller AF. Paclitaxel and platinum chemotherapy for malignant mixed müllerian tumors of the ovary. Gynecol Oncol 2002; 85: 459-63
8. Andersen WA, Young DE, Peters WA, Smith EB, Bagley CM, Taylor PT. Platinumbased combination chemotherapy for malignant mixed mesodermal tumors of the ovary. Gynecol Oncol 1989; 32: 319-22
9. Moore M, Fine S, Sturgeon J. Malignant mixed mesodermal (MMM) tumors of the ovary: the Princess Margaret Hospital (PMH) experience. Proc Am Soc Clin Oncol 1986; 5: 114
10.Morrow CP, d'Ablaing G, Brady LW, Blessing JA, Hreshchyshyn MM. A clinical and pathologic study of 30 cases of malignant mixed mullerian epithelial and mesenchymal ovarian tumors: a gynecologic oncology group study. Gynecol Oncol 1984; 18: 278-92
11.Patsner B, Greenberg S. Mesna, doxorubicin, ifosfamide, and dacarbazine chemotherapy for ovarian mixed mullerian sarcoma: report of four cases. Gynecol Oncol 1995; 58: 386-8
12.Piver MS, DeEulis TG, Lele SB, Barlow JJ. Cyclophosphamide, vincristine, adriamycin, and dimethyl-triazeno imidazole carboxamide (CYVADIC) for sarcomas of the female genital tract. Gynecol Oncol 1982; 14: 319-23
13.Sood AK, Sorosky JI, Gelder MS, Buller RE, Anderson B, Wilkinson EJ, et al. Primary ovarian sarcoma: analysis of prognostic variables and the role of surgical cytoreduction. Cancer 1998; 82: 1731-7
14.Rutledge TL, Gold MA, McMeekin DS, Huh WK, Powell MA, Lewin SN, et al. Carcinosarcoma of the ovary-a case series. Gynecol Oncol 2006; 100: 128-32
15.Gari A, Souhami L, Arseneau J, Stanimir G. Primary malignant mesodermal ovarian sarcomas. Int J Gynecol Cancer 2006; 16: 106-9
16.Tate Thigpen J, Blessing JA, DeGeest K, Look KY, Homesley HD; Gynecologic Oncology Group. Cisplatin as initial chemotherapy in ovarian carcinosarcoma: A Gynecologic Oncology Group study. Gynecol Oncol 2004; 93: 336-9
17.Chang J, Sharpe JC, A'Hern RP, Fisher C, Blake P, Shepherd J, et al. Carcinosarcoma of the ovary: incidence, prognosis, treatment and survival of patients. Ann Oncol 1995; 6: 755-8
18.Zorzou MP, Markaki S, Rodolakis A, Kastritis E, Bozas G, Dimopoulos MA, et al.Clinicopathological features of ovarian carcinosarcomas: A single institution experience. Gynecol Oncol 2005; 96: 136-42